Eating Disorder Screening Guide for Healthcare Professionals

Introduction: Your Essential Role in Early Detection

Dear colleagues, as healthcare professionals in France, you're often the first to witness the hidden struggle of eating disorders in your patients. An unexplained weight loss in a teenager, recurring dental issues in a young professional, chronic fatigue in a working parent... Behind these symptoms often lie eating disorders affecting nearly 900,000 people in France.

As a specialized eating disorder dietitian with over 10 years of experience in Paris, I've observed that the average time to diagnosis is 3-5 years. This diagnostic wandering isn't inevitable. With the right tools and appropriate referral pathways, we can dramatically transform these patients' care journey.

This guide, designed as a practical toolkit, synthesizes official French health authority (HAS) recommendations, specialized association resources, and clinical best practices. It will enable you to detect earlier, refer more effectively, and coordinate truly therapeutic care.

Recognizing Warning Signs: Beyond Weight

Early Somatic Manifestations

Eating disorders are never just about weight. Somatic signals are multiple and often overlooked:

Digestive and Oral Signs:

• Dental erosion (lingual surface of incisors) suggesting vomiting

• Bilateral parotid hypertrophy

• Chronic refractory constipation

• Persistent gastroesophageal reflux

• Functional abdominal pain

Metabolic and Endocrine Signs:

• Amenorrhea or oligomenorrhea (>3 months)

• Resting bradycardia (<60 bpm)

• Orthostatic hypotension

• Excessive cold sensitivity, cold extremities

• Paradoxical refeeding edema

Behavioral Indicators

Beyond physical symptoms, certain behaviors should alert you:

During Consultation:

• Categorical refusal of weighing or extreme anxiety

• Systematic minimization of symptoms

• Highly controlled discourse about food

• Paradoxical nutritional hyperknowledge

• Systematic wearing of loose clothing

Reported by Family:

• Progressive social isolation, especially at meals

• Rigid food rituals (cutting into tiny pieces, specific eating order)

• Compulsive physical hyperactivity

• Disappearing to bathroom after meals

• Unexplained massive food purchases

Validated Screening Tools: Simple and Effective

The SCOFF Questionnaire: 5 Questions to Screen

The SCOFF questionnaire remains the gold standard recommended tool:

The 5 SCOFF Questions:

1. S - Do you make yourself Sick because you feel uncomfortably full?

2. C - Do you worry you have lost Control over how much you eat?

3. O - Have you recently lost more than One stone (6kg) in 3 months?

4. F - Do you believe yourself to be Fat when others say you are thin?

5. F - Would you say Food dominates your life?

Interpretation: ≥ 2 positive answers = positive screening Performance: Sensitivity 94.6% - Specificity 94.7%

SOS Anor Test: The "Anorexic Mindset" Approach

SOS Anor offers a revolutionary approach with their online test (sosanor.org/tca-le-test/) exploring the mental functioning pattern typical of eating disorders rather than eating behaviors:

• Focus on perfectionism and control

• Cognitive rigidity assessment

• Conditional self-esteem exploration

• All-or-nothing thinking analysis

This approach helps detect atypical eating disorders and subsyndromal forms often invisible to classic questionnaires.

Referral Protocols: The Right Pathways

HAS Care Gradation

The French Health Authority defines 3 levels of care:

Level 1 - Non-specialized Local Care:

• Trained general practitioner

• Pediatrician or school doctor

• Community mental health centers

• Trained private dietitians → For: Screening, initial assessment, early eating disorders

Level 2 - Specialized Local Care:

• Hospital eating disorder consultations

• Day hospitals

• Mobile eating disorder teams

• Coordinated care networks → For: Confirmed eating disorders requiring expertise

Level 3 - Regional Reference Centers:

• Specialized eating disorder units

• Reference centers

• Full-time hospitalization → For: Complex cases, therapeutic failures, vital emergencies

Immediate Referral Criteria

To Emergency Department:

• BMI < 14 kg/m² (adult) or < 3rd percentile (child)

• Bradycardia < 40 bpm or rhythm disorders

• Hypokalemia < 3 mmol/L

• Symptomatic hypoglycemia

• Suicidal ideation with plan

Official Resources: Your Support Network

FFAB: Reference Federation

The French Federation Anorexia Bulimia structures national expertise since 2002:

Contact:

• Website: ffab.fr

• Email: ffabtca@gmail.com

• Social media: @ffabtca (Twitter/X), @tout.sur.les.tca (Instagram)

Professional Resources:

• National directory of specialized centers (updated 2021)

• Best practice recommendations

• Free regional training (National Plan)

• University diploma programs

Specialized Helpline

Anorexia Bulimia Info Line: 09 69 325 900

• Hours: 4-6pm, Monday/Tuesday/Thursday/Friday

• Specialized professionals by day

• Support for patients, families AND professionals

• Referral to appropriate resources

MONPROTCA Platform: Finding the Right Professional

The monpro-tca.com website revolutionizes referral by guaranteeing truly trained professionals:

Strict referencing criteria:

• Validated specific eating disorder training

• Significant clinical experience

• Non-restrictive, compassionate approach

• Regular continuing education

• Multidisciplinary network collaboration

Interprofessional Coordination: Key to Success

Recommended Minimum Team

Effective care requires at minimum:

• Referring physician: Somatic monitoring, coordination

• Mental health professional: Psychologist/psychiatrist for psychopathological aspects

• Dietitian nutritionist: Non-restrictive nutritional rehabilitation

Best Communication Practices

• Designate a clearly identified care coordinator

• Establish regular consultation schedule

• Use standardized liaison tools

• Respect shared confidentiality with patient agreement

• Involve patient as active team member

Practical Advice: Optimizing Your Practice

During Consultation

Creating Trust:

• Avoid any judgment about weight or appearance

• Use neutral, compassionate vocabulary

• Respect resistance without confrontation

• Validate the consultation process

• Offer regular follow-up without pressure

Helpful Phrases:

• "I understand this is difficult to talk about"

• "We'll move at your pace"

• "Your suffering is legitimate and deserves to be heard"

• "Solutions exist, we'll find them together"

Common Pitfalls to Avoid

• ❌ Focusing only on weight

• ❌ Prescribing restrictive diets

• ❌ Minimizing if BMI is "normal"

• ❌ Blaming or moralizing

• ❌ Promising quick recovery

• ❌ Working alone without network
  
  
  
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  📚 SOURCES ET RÉFÉRENCES

  • HAS - Boulimie et hyperphagie : recommandations 2019

  • HAS - Anorexie mentale : prise en charge 2010

  • FFAB - Fédération Française Anorexie Boulimie

  • FNA-TCA - Fédération Nationale des Associations

  • SOS Anor - Test et ressources

  • MonProTCA - Annuaire professionnel

  • Réseau TCA Francilien

  • GROS - Groupe de Réflexion sur l'Obésité et le Surpoids